Coronary artery bypass grafting device

ABSTRACT

A coronary artery bypass grafting device includes a plurality of attachment members each having: a flexible tube ( 102 ); a suction cup portion ( 101 ) provided in a tip end side of the flexible tube ( 102 ); a three-way cock ( 103 ) provided in the flexible tube ( 102 ); and a holding member ( 104 ) that holds the flexible tube ( 102 ). At least one of the attachment members further includes a duckbill valve ( 111 ) provided in the flexible tube ( 102 ).

TECHNICAL FIELD

The present invention relates to a coronary artery bypass graftingdevice.

BACKGROUND ART

In recent years, catheter intervention for patients suffering from anischemic heart disease such as myocardial infarct has been increasinglywidespread. Typical catheter intervention includes percutaneoustransluminal coronary angioplasty or intravascular stent placement.These treatments are less invasive and require a short stay in ahospital.

On the other hand, effectiveness of coronary artery bypass grafting(hereinafter referred to as CABG) has been widely recognized forpatients who cannot undergo the catheter treatment. This method isintended for anastomosing one end of a bypass blood vessel such as anablated internal thoracic artery or gastroepiploic artery to aperipheral side of a coronary artery with stenosis that may causeischemia to eliminate the ischemia.

Patients who undergo the CABG often have a plurality of coronaryarteries with obstruction or stenosis, a calcified ascending aorta, achronic disease of brain, kidney, or a respiratory organ, and areelderly people, and thus the CABG may pose substantial risk to thepatients. The highest risk to the patients is to stop the heart and usea heart-lung machine for extracorporeal circulation. Applying theheart-lung machine to patients with advanced arteriosclerosis is likesupplying water to a rusty water pipe under high pressure. Thus,accretions in a blood vessel may be swept away to block another bloodvessel, thereby causing a complication such as brain infarct and thelike.

For such patients, an attempt has been made to anastomose a bypass graftwithout a heart-lung machine while the heart is beating, andsatisfactory results have been achieved. This method is called off-pumpcoronary artery bypass (hereinafter abbreviated as OPCAB).

The problem of the OPCAB is that performing a complete anastomosis in ashort time requires skills because the heart is beating. An imperfectanastomosis may cause a blood clot to form in a coronary artery or abypass blood vessel from the anastomosis portion to cause obstruction.For this problem, a stabilizer is used to control movement of theanastomosis portion and allow the anastomosis of the bypass blood vesselin a stable manner, thereby increasing accuracy of the anastomosis andsignificantly increasing the results of the OPCAB (Patent Document 1).

Further, in order to increase accuracy of an anastomosis of an affectedarea that is difficult to anastomose because the area cannot be seenfrom the front in a normal state, a device is disclosed that is attachedto and holds the heart to adjust the position of the heart (PatentDocument 2). The device disclosed in Patent Document 2 includes onesuction cup portion attachable to a heart wall surface, one arm foradjusting the position of the suction cup portion, and a suction tubethat communicates with the suction cup portion and is connectable to asuction source. This device, however, adjusts the position of the heartby a force from one direction, which may cause displacement or fall ofthe heart during the anastomosis with the position of the heart beingadjusted.

[Patent Document 1] U.S. Pat. No. 5,836,311

[Patent Document 2] International Publication No. 02/054937

DISCLOSURE OF THE INVENTION

The present invention is achieved in view of the above describedcircumstances, and provides a coronary artery bypass grafting devicethat can adjust the position of the heart with little displacement orfall of the heart and perform an anastomosis with safety in an affectedarea that is difficult to anastomose in off-pump coronary artery bypass.

According to the present invention, there is provided a coronary arterybypass grafting device comprising a plurality of attachment members eachincluding: a flexible tube; a suction cup portion provided in a tip endside of the flexible tube; a switching (an opening and closing) memberprovided in the flexible tube; and a holding member that holds theflexible tube, at least one of the attachment members further includinga check valve provided in the flexible tube.

The coronary artery bypass grafting device according to the presentinvention is a device for holding a subject to be attached,specifically, the heart in a predetermined position. The coronary arterybypass grafting device according to the present invention includes theplurality of attachment members, and at least one of the attachmentmembers includes the check valve. The plurality of attachment memberseach has the suction cup portion. Thus, the coronary artery bypassgrafting device according to the present invention includes a pluralityof suction cup portions. This allows the subject to be attached,specifically, the heart to be held at a plurality of positions. Thisallows the heart to be held in the predetermined position in a stablemanner. At least one of the attachment members includes the check valve,and thus even if a suction cup portion in one of the attachment memberis detached from the heart, as for the other suction cup portionattached on the heart, the vacuum breakdown is prevented and thenegative pressure is kept therein, keeping the suction cup portionattached to the heart. This allows an anastomosis procedure in coronaryartery bypass grafting to be performed in a stable manner.

According to the present invention, there is provided a coronary arterybypass grafting device comprising a plurality of attachment members eachincluding: a flexible tube; a suction cup portion provided in a tip endside of the flexible tube; a switching (an opening and closing) memberprovided in the flexible tube; a holding member that holds the flexibletube; and a check valve provided in the flexible tube.

The coronary artery bypass grafting device according to the presentinvention is a device for holding the heart in a predetermined position.The coronary artery bypass grafting device according to the presentinvention includes a plurality of suction cup portions. Thus, the devicemay adjust the position of the heart from a plurality of directions. Thedevice includes the plurality of suction cup portions to allow the heartto be reliably held in the predetermined position. Further, the deviceincludes the plurality of attachment members having the check valves,and thus even if one suction cup portion is detached from the heart, asfor the other suction cup portion attached on the heart, the vacuumbreakdown is prevented, allowing the heart to be held by the othersuction cup portions. This allows an anastomosis procedure in coronaryartery bypass grafting to be performed in a stable manner.

In the present invention, the check valve is a valve adapted to beclosed when the backflow of a fluid flowing from a base end side (theside of a suction source) to a tip end side (the side of the suction cupportion) of the check valve without external operation. Providing such acheck valve, when a suction cup portion is detached from the subject tobe attached, since the pressure inside thereof is relatively positivepressure with respect to the pressure in the suction cup portionattached thereon and the backflow is occurred by the differentialpressure therebetween eliminates the need for an operator to open andclose the check valve and the check valve provided in the attachmentmember attached on the subject to be attached is closed state so as tokeep the pressure inside the attached suction cup portion, that is, thevacuum breakdown is prevented. This allows an operation during thecoronary artery bypass grafting to be performed with greater safety.

For example, in the present invention, the check valve may have a coupleof valve bodies which is in contact with each other at tips of the valvebodies and is to be a closed state, and be adapted to be opened when thebase end side of the check valve is in a negative pressure with respectto the suction cup portion, and closed when the base end side of thecheck valve is relatively in a positive pressure with respect to thesuction cup portion. In the present invention, the check valve may be aduckbill valve.

In the present invention, the check valve provided in the flexible tubeprovided with the suction cup portion may be adapted to vibrate andgenerate a leak sound when the suction cup portion attached to thesubject to be attached under a predetermined suction pressure isdetached with the suction pressure being applied. This allows occurrenceof a detachment of the suction cup portion to be quickly reported to theoperator, thereby allowing the procedure by the coronary artery bypassgrafting to be performed with greater safety. Also, in the presentinvention, the check valves for the prevention of the vacuum breakdownand for the generation of the leak sound may be provided separately.Thus, for example, the check valve for the prevention of the vacuumbreakdown can be formed by the material with low hardness to improve thedeforming ability thereof, the adhesiveness between the couple of valvebodies, and the ability for preventing the vacuum breakdown, while thecheck valve for the generation of the leak sound can be formed by thematerial with high hardness to make easier to vibrate and thus togenerate the leak sound with higher frequency.

In the coronary artery bypass grafting device according to the presentinvention, at least one of the attachment members may further include anauxiliary member used for placing the suction cup portion in thepredetermined position on the subject to be attached. This allows thesuction cup portion to be more reliably placed in the predeterminedposition using the auxiliary member.

In the coronary artery bypass grafting device according to the presentinvention, the device may include at least three attachment members.This allows the suction cup portions to be placed in three or morepositions on a heart wall surface. This restrains torsion of the heartas compared with the suction cup portions being placed in two positionsonly. This allows the heart to be more reliably held in thepredetermined position. This allows the anastomosis in the coronaryartery bypass grafting to be performed with greater safety.

In the coronary artery bypass grafting device according to the presentinvention, the device may include a connecting member that connects thesuction cup portion and the flexible tube between the suction cupportion and the flexible tube, and the connecting member is adapted toallow one of the suction cup portion and the flexible tube to moverelative to the other. In the coronary artery bypass grafting device,the connecting member may communicate with the suction cup portion andthe flexible tube, and be adapted so that the orientation of one of thesuction cup portion and the flexible tube is variable relative to theother. This allows the attitude of the one of the suction cup portionand the flexible tube to with respect to the other to be freely varied.This increases the degree of freedom of movement of the attachmentmember when the position is adjusted. This allows the position of theheart to be more reliably adjusted.

In the coronary artery bypass grafting device according to the presentinvention, the connecting member may include a bellows tube thatcommunicates with the suction cup portion and the flexible tube. Thisallows one of the suction cup portion and the flexible tube to reliablymove relative to the other to increase the degree of freedom of relativeorientation.

In the coronary artery bypass grafting device according to the presentinvention, an angular movable range of the flexible tube relative to thesuction cup portion may be not less than 30 degrees and not more than180 degrees in a horizontal plane parallel to an attachment surface ofthe suction cup portion. In the coronary artery bypass grafting deviceaccording to the present invention, an angular movable range of theflexible tube relative to the suction cup portion may be not less than30 degrees and not more than 180 degrees in a vertical planeperpendicular to the attachment surface of the suction cup portion. Thisallows the heart to be reliably held in the predetermined position whileallowing the position of the heart to be adjusted. In the specification,the angular movable range refers to a range of angles in which theflexible tube can move relative to the suction cup portion.

In the coronary artery bypass grafting device according to the presentinvention, the suction cup portion may further include: a communicationopening that communicates with the flexible tube; and a plurality ofslit-like concaves extending from an end of the suction cup portiontoward the communication opening. This provides a device with a lowerrisk of displacement or fall of the heart. In the present invention, theplurality of concaves may extend substantially perpendicularly (in asuction direction) to the attachment surface of the suction cup portionand be provided in parallel with each other.

In the coronary artery bypass grafting device according to the presentinvention, the end of the suction cup portion may be softer than theinside of the suction cup portion. In the coronary artery bypassgrafting device according to the present invention, the end of thesuction cup portion may be formed of a member softer than the inside ofthe suction cup portion. This allows the suction cup portion to bereliably attached to the heart.

In the coronary artery bypass grafting device according to the presentinvention, the flexible tube may include a main tube, a branch portionthat communicates with the main tube, and a plurality of auxiliary tubesthat communicate with the branch portion, and a plurality of suction cupportions may be provided in different auxiliary tubes. This allows areduction in size of the whole device and also increases controllabilityof the attachment member.

In the coronary artery bypass grafting device according to the presentinvention, the device may include three or more auxiliary tubes.

In the coronary artery bypass grafting device according to the presentinvention, the plurality of suction cup portions may communicate withone suction unit via the flexible tube. This ensures the reduction insize of the whole device. The plurality of attachment members may beadjusted using one suction unit, thereby increasing workability in theprocedure. Further, the check valve is provided in the flexible tube,and even if one attachment member is detached from the heart, as for theother attachment members attached to the heart vacuum is not broken, andthus the heart may be held by the other attachment members, therebyincreasing safety.

In the coronary artery bypass grafting device according to the presentinvention, the three or more suction cup portions may communicate withone suction unit via the flexible tube.

In the coronary artery bypass grafting device according to the presentinvention, the switching member and the check valve may be provided inthe flexible tube in this order from the suction cup portion provided inthe tip end side of the flexible tube to the base end side, in at leastone of the attachment members. Such an arrangement ensures the effectsof the check valve, and allows a predetermined suction cup portion to bereliably attached to and detached from the subject to be attached.

In the coronary artery bypass grafting device according to the presentinvention, the suction cup portion may include a plurality of suctioncups in at least one of the attachment members.

According to the present invention, there is also provided a coronaryartery bypass grafting device including a suction cup portion in a tipend side of a flexible tube, the suction cup portion including aplurality of suction cups.

The coronary artery bypass grafting device according to the presentinvention includes the plurality of suction cups in the tip end side ofone flexible tube, and thus has good followability in attachment to acurved portion besides to a substantially planar portion on the heartwall surface, thereby allowing the heart to be more reliably held in thepredetermined position. This allows the anastomosis in the coronaryartery bypass grafting to be performed with greater safety.

In the coronary artery bypass grafting device according to the presentinvention, the shape of the suction cup may be substantially circular.

According to the present invention, there is provided a method forsurgically treating the heart using the above described coronary arterybypass grafting device.

According to the method of the present invention, a plurality of suctioncup portions can be attached to the heart, and thus the suction cupportions can be attached to a plurality of positions on the heart tohold the heart in a stable manner. when a suction cup portion isdetached from the subject to be attached, since the pressure insidethereof is relatively positive pressure with respect to the pressure inthe suction cup portion attached thereon and the backflow is occurred bythe differential pressure therebetween, the check valve provided in theattachment member attached on the subject to be attached is closed stateso as to keep the pressure inside the attached suction cup portion, thatis, the vacuum breakdown is prevented. This allows a procedure on theheart to be performed with safety.

Specifically, the method of the present invention may include: placingone suction cup portion in a predetermined position on a heart wallsurface when the heart is in a first position; applying a suctionpressure to the one suction cup portion and attaching the one suctioncup portion to the predetermined position; placing the other suction cupportion in the other position on the heart wall surface; applying asuction pressure to the other suction cup portion by a suction sourcethat applies the suction pressure to the one suction cup portion andattaching the other suction cup portion to the other position; pullingand holding one holding member that holds a flexible tube provided withthe one suction cup portion and the other holding member that holds aflexible tube provided with the other suction cup portion to hold theheart in a second position; and surgically treating the heart in thesecond position.

The method of the present invention may also include: placing onesuction cup portion in a predetermined position on a heart wall surfacewhen the heart is in a first position; applying a suction pressure tothe one suction cup portion and attaching the one suction cup portion tothe predetermined position; placing another suction cup portion inanother position on the heart wall surface; applying a suction pressureto another suction cup portion by a suction source that applies thesuction pressure to the one suction cup portion and attaching anothersuction cup portion to another position; placing a further suction cupportion in a further position on the heart wall surface; applying asuction pressure to the further suction cup portion by a suction sourcethat applies the suction pressure to the one suction cup portion andattaching the further suction cup portion to the further position;pulling and holding one holding member that holds a flexible tubeprovided with the one suction cup portion, another holding member thatholds a flexible tube provided with another suction cup portion, and afurther holding member that holds a flexible tube provided with thefurther suction cup portion to hold the heart in a second position; andsurgically treating the heart in the second position.

In the method of the present invention, at least one of the attachmentmembers may further include an auxiliary member used for placing thesuction cup portion in a predetermined position on a subject to beattached, and the above described placing one suction cup portion in thepredetermined position on the heart wall surface may include placing theone suction cup portion in the predetermined position with the auxiliarymember.

According to the present invention, there is provided a coronary arterybypass grafting device that can adjust the position of the heart withlittle displacement or fall of the heart in an affected area that isdifficult to anastomose, and perform an anastomosis with safety.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other objects, advantages and features of the presentinvention will be more apparent from the following description taken inconjunction with the accompanying drawings, in which:

FIG. 1 is a drawing schematically showing a configuration of a coronaryartery bypass grafting device related to an embodiment;

FIG. 2 is a drawing schematically showing a configuration of a coronaryartery bypass grafting device related to an embodiment;

FIG. 3 is a drawing schematically showing a configuration of a coronaryartery bypass grafting device related to an embodiment;

FIG. 4 is a drawing schematically showing a configuration of a suctioncup portion of a coronary artery bypass grafting device related to anembodiment;

FIG. 5 is a drawing schematically showing a configuration of a suctioncup portion of a coronary artery bypass grafting device related to anembodiment;

FIG. 6 is a drawing schematically showing a configuration of a coronaryartery bypass grafting device related to an embodiment;

FIG. 7 is a drawing schematically showing a configuration of suction cupportions of a coronary artery bypass grafting device related to anembodiment;

FIG. 8 is a drawing schematically showing a configuration of suction cupportions of a coronary artery bypass grafting device related to anembodiment;

FIG. 9 is a drawing schematically showing a configuration of a coronaryartery bypass grafting device related to an embodiment;

FIG. 10 is a drawing schematically showing a configuration of aninsertion assisting member of a coronary artery bypass grafting devicerelated to an embodiment; and

FIG. 11 is a drawing schematically showing a method of using a coronaryartery bypass grafting device related to an embodiment.

BEST MODE FOR CARRYING OUT THE INVENTION

Embodiments of the present invention will be described with reference todrawings as follows. Here, like reference numerals or characters will begiven to designate the common components throughout the figures thereof,and detailed descriptions thereon will not be appropriately representedin the following descriptions.

A coronary artery bypass grafting device described below is aninstrument of fixing a heart at a predetermined position. This device ispreferably used when a heart undergoes a predetermined treatment, forexample, coronary artery bypass grafting and the like.

First Embodiment

FIG. 1 is a drawing showing an example of a coronary artery bypassgrafting device of the present invention. The coronary artery bypassgrafting device shown in FIG. 1 has a plurality of, preferably more thanor equal to three, attachment members. FIG. 1 exemplifies aconfiguration provided with three attachment members.

An attachment member includes a flexible tube 102, a suction cup portion101 provided at a side of a tip of the flexible tube 102, a three-waycock 103 being an opening and closing member provided to the flexibletube 102, a holding member 104 of holding the flexible tube 102 and aduckbill valve 111 being a check valve provided to the flexible tube102. Here, FIG. 1 exemplifies a configuration for all three attachmentmembers to include respective duckbill valves 111, but at least one of aplurality of attachment members may include a duckbill valve 111.

In the coronary artery bypass grafting device shown in FIG. 1, theflexible tube 102 includes a main tube, a triple joint 105 being abranching part in communication to the main tube and three auxiliarytubes in communication to the triple joint 105, that is, each of thethree attachment members has a mutually different auxiliary tube. Here,the triple joint 105 is configured to bring four pipes, one pipe for themain tube side and three pipes for the auxiliary tube sides, into mutualcommunication in the branching part. Therefore, auxiliary tubesconfiguring the attachment members are configured to be interconnectedeach other with a triple joint 105 and the like. In addition, the otherend of the flexible tube 102, that is, an end portion of the main tubeis connected to a suction source 106. And, the three suction cupportions 101 are connected to a single suction source 106 through aflexible tube 102. The suction source 106 can be, for example, a vacuumpump and the like.

Materials for the flexible tube 102 can be materials such as, forexample, polyurethane resin, flexible vinyl chloride resin and siliconeresin and the like. In addition, the flexible tube 102 is formed by, forexample, extrusion molding. Sizes of the flexible tube 102 can beconfigured by the entire length of, for example, more than or equal to50 mm, preferably more than or equal to 100 mm, and the inner diameterof, for example, more than or equal to 2 mm, preferably more than orequal to 4 mm. In addition, a reinforcing member such as a metal coil,film or fabric and the like may be employed to reinforce the flexibletube 102. Thus, interruption of suction due to a kink can be prevented.Therefore, the kink resistant nature of the flexible tube 102 can beimproved.

In the coronary artery bypass grafting device shown in FIG. 1, thesuction cup portion 101 is provided at the tip end side of the flexibletube 102. In particular, as aforementioned, the three suction cupportions 101 are respectively connected to the end portions of the threeauxiliary tubes branching from a single main tube. The suction cupportions 101 suctions with the suction source 106 through the flexibletubes 102. Suction causes attachment onto a surface of a subject to beattached and sucked.

Here, the subject to be attached is a heart. This can make the suctioncup portion 101 become a material excellent in the tight contact natureto a heart wall surface. The material of the suction cup portion 101 canbe, for example, an elastomeric substance. This arrangement will giverise to sufficient fitting onto heart wall surfaces so that the tightcontact nature can be ensured. In particular, the material of thesuction cup portion 101 is preferably silicone resin,stylene-ethylene-butadiene-stylene resin and elastomer such as urethaneelastomer and the like.

In addition, the suction cup portion 101 can be shaped into a pad. Theshape of the suction cup portion 101 in a plan view can be, for example,circular. In addition, not only circular shape but also approximatelyoval shape as shown in the drawings can be employed. Being shaped ovalinstead of shaped plane, the suction cup portion 101 can be brought intoattachment onto a heart wall surface at the largest contact area withoutsuctioning blood vessels on the hear wall surface.

In addition, sizes of the suction cup portion 101 can be in terms ofdiameter, for example, more than or equal to 5 mm, preferably more thanor equal to 10 mm in case of the plane shape being circular. Thus, thesuction cup portion 101 can be brought into attachment onto a heart wallsurface more stably. In addition, the diameter of the suction cupportion 101 can be made to be, for example, less than or equal to 60 mm,preferably less than or equal to 50 mm. Thus, the suction cup portion101 can be made compact and therefore workability can be improvedfurther also in the case where a plurality of suction cup portions 101are arranged on a heart wall surface.

In addition, in case of the plane shape of the suction cup portion 101being approximately an oval shape, the length thereof in thelongitudinal direction can be made, for example, more than or equal to20 mm, preferably more than or equal to 30 mm, from the point of viewfor causing the suction cup portion 101 to be brought into attachmentonto the heart wall surface more stably. In addition, from the point ofview of further improving workability, the length in the longitudinaldirection can be made, for example, less than or equal to 60 mm,preferably less than or equal to 50 mm. Moreover, the length of thesuction cup portion 101 in the short side direction can be made, forexample, more than or equal to 5 mm, preferably more than or equal to 10mm, from the point of view for causing the suction cup portion 101 to bebrought into attachment onto the heart wall surface more stably. Inaddition, from the point of view of further improving workability, thelength in the short side direction can be made, for example, less thanor equal to 30 mm, preferably less than or equal to 20 mm. In addition,the height of the suction cup portion 101 can be made, for example, notless than 5 mm and not more than 30 mm.

Configurations of the length of the suction cup portion 101 as describedabove can ensure to bring the suction cup portion 101 into attachmentonto a heart surface so that the heart is fixed. In addition, as thesuction cup portion 101 is being stably fixed onto the heart surface,treatment workability can be secured.

The shape of the suction cup portion 101 of the coronary artery bypassgrafting device shown in FIG. 1 is preferably made to be in a taperedshape with the diameter getting larger toward the end portion of thesuction cup portion 101. This can restrain the suction cup portion 101from being deformed inward due to suction pressure at the time ofsuction contact with the heart wall. In addition, the sizes or theshapes of a plurality of suction cup portions 101 are not necessarilyuniform respectively, but, for example, the suction cup portion 101 thatis caused to fit into the cardiac apex of a heart may be made thelargest. This arrangement can ensure a heart to be held at apredetermined position.

In addition, the suction cup portion 101 may be provided with an openingon the attachment surface. The opening can be configured to be incommunication with the flexible tube 102. In addition, a mesh and thelike with a plurality of small holes which covers the opening of thesuction cup portion 101 may be disposed. At this time, the heart wallsurface will be configured to contact the suction cup portion 101through the mesh.

In addition, a convex part may be provided around the suction opening sothat space is provided between there and the suction opening. This canprevent decrease in the suction area. Consequently, the suction power inthe suction cup portion 101 can be caused to improve. Material of themesh and the like can be polyester fabric such as polyethyleneterephthalate and the like, polyamide fabric such as nylon and the likeor water-absorbing unwoven fabric or cotton.

In addition, a plurality of concave slits (slits 108) are preferablyformed in the inner surface of the opening provided in the suction cupportion 101. FIG. 4( a) to FIG. 4( e) are drawings to describe aconfiguration of a suction cup portion 101 having slits. FIG. 4( a) is afront view of the suction cup portion 101. FIG. 4( b) is a top view ofthe suction cup portion 101. FIG. 4( c) is a bottom view of the suctioncup portion 101. FIG. 4( d) is a sectional view along the line A to A′in FIG. 4( b). In addition, FIG. 4( e) is a sectional view along theline B to B′ in FIG. 4( b).

FIGS. 4A to 4E exemplify a case of a suction cup portion 101 being arectangle provided with R in corners. In this configuration, the suctioncup portion 101 is further provided with a communication opening (notshown in the drawings) in communication to the flexible tube 102 and aplurality of slit-shaped concave portions (slits 108) extending towardthe communication opening from the end portion of the suction cupportion 101. The slits 108 are grooves formed in the inner surface ofthe suction cup portion 101. Providing the slits 108, liquid inside thesuction cup portion 101 can be discharged efficiently to the flexibletube 102 from the slits 108 via the communication opening. Consequently,the discharge route can be made never to be blocked by liquid that mightcollect inside the suction cup portion 101 and the draining effects ofdraining body fluid and the like on tissue surfaces can be derived,which can prevent the suction cup portion 101 from lateral slidingagainst tissues. In addition, as shown in FIG. 4( c) to FIG. 4( e), aplurality of concave slits (slits 108) can be configured to extend in adirection (suction direction) substantially perpendicular to theattachment surface and to be provided in substantially parallel eachother.

In addition, a plurality of slits 108 extend from the center of thesuction cup portion 101 to its circumference and are formed radially.This allows efficient discharge of liquid in the suction cup portion 101from the interior to the exterior of the opening. In addition, aplurality of slits 108 may be provided in the circumferential directionof the inner surface of the suction cup portion 101. Moreover, the slits108 are preferably formed to reach in the vicinity of the end portion ofthe suction cup portion 101. This will give rise to an effect thatsuction pressure can be applied to reach the end portion of the suctioncup portion 101 in an ensured fashion in addition to the above describeddraining effect. Therefore, the suction power can be caused to improve.

The width of the slits 108 is preferably, for example, not less than 0.2mm and not more than 1 mm and the depth thereof is preferably not lessthan 0.5 mm and not more than 5 mm. This can restrain tissues fromcompletely infiltrating into the slits 108 to deteriorate the drainingeffects of the slits. This can improve the draining effects of thesuction cup portion 101.

In addition, in the coronary artery bypass grafting device shown in FIG.1, the end portion of the suction cup portion 101 is preferably a softor pliable site. FIG. 5 is a sectional view schematically showing aconfiguration of thus configured suction cup portion 101. In FIG. 5, theend portion of the suction cup portion 101 is provided with a pliablemember 109 and therefore the end portion of the suction cup portion 101configures a pliable portion. As shown in FIG. 5, the tip end portion,in particular the outer periphery of the opening, of the suction cupportion 101 is provided with a pliable member 109 and thereby the endportion of the suction cup portion 101 can be configured by a membersofter than the interior of the suction cup portion 101. In addition,the end portion of the suction cup portion 101 is made softer than theinterior of the suction cup portion 101. Thus, the nature of the suctioncup portion 101 to follow pliable tissues is improved so that thesuction power can be caused to improve.

As a method of making the end portion of the suction cup portion 101pliable, provision of the end portion of the suction cup portion 101that is made thinner than the portions other than the end portion anddisposition of another pliable member can be employed. As another methodof deriving pliability, a method of making hardness of the end portionlower by, for example, more than or equal to 20% than hardness of thesuction cup portion 101 can be employed. As a material like this, theone having the same hardness as the above described suction cup portion101 with only material having been made low and a closed-cell sponge ora gel material and the like can be employed.

Now back to FIG. 1, the coronary artery bypass grafting device isprovided with a holding member 104 of holding the flexible tube. Theholding member 104 adjusts the position of the suction cup portion 101to hold it at a predetermined position. The holding member 104 is formedby, for example, extrusion molding.

The holding member 104 should be, for example, a stick or tube member.Thus, the end portion of the holding member 104 being grasped toimplement remote operation ensures disposition of the suction cupportion 101 to a predetermined location. In addition, at this time, thesizes of the holding member 104 can be configured by the entire lengthof, for example, more than or equal to 200 mm, preferably more than orequal to 300 mm. Thus the suction cup portion 101 can be held morestably. In addition, there is no particular limits to the upper limitfor the entire length of the holding member 104, but from the point ofview of ensuring a field of view more sufficiently at the time oftreatment, for example, less than or equal to 1000 mm, preferably lessthan or equal to 800 mm, can be taken. In addition, the outer diameterof the holding member 104 can be made, for example, more than or equalto 2 mm, preferably more than or equal to 3 mm. This enables hardness ofthe holding member 104 to be improved further. In addition, there is noparticular limits to the upper limit for the outer diameter of theholding member 104, but from the point of view of making the graftingdevice compact, for example, less than or equal to 10 mm, preferablyless than or equal to 8 mm, can be taken.

As the material of the holding member 104, a material is preferablyunbreakable. This can ensure adjustment of the position of the suctioncup portion 101 to hold the suction cup portion 101 at a desiredposition. The material of the holding member 104 can be metal, forexample, stainless steel and the like. In addition, resin materials suchas polyamide resin, polycarbonate resin, rigid vinyl chloride resin,silicone resin and the like can be employed. In case of employing anelastomer such as silicone resin and the like, appropriate expansion ofthe holding member enables absorption of heart beats so that the heartcan be held more stably.

In addition, in the coronary artery bypass grafting device shown in FIG.1, the flexible tubes 102 in communication to a plurality of the suctioncup portions 101 brought into attachment onto a heart wall surface andrespective holding members 104 may be fixed to a rib retractor and thelike with traction forceps and the like. By fixing the flexible tubes102 and the holding members 104 to a rib retractor and the like withtraction forceps and the like to adjust the position of a heart, theposition of the heart can be adjusted from not only one direction butalso from a plurality of directions. Therefore, displacement of a heartduring anastomosis, or risks of fall of a heart can be caused todecrease. In addition, the holding member 104 may be, for example,configured to be able to slide at any site on a flexible tube 102, andmay be configured to be able to be fixed to the flexible tube 102 at thetime of pulling the holding member 104. This can improve pullingoperability.

In addition, in the coronary artery bypass grafting device shown in FIG.1, by adjusting the three-way cock 103 provided in the main tube toleave it in an interrupted state so as not to bring the suction source106 into communication to the auxiliary tubes, and adjusting thethree-way cock 103 after bringing the suction cup portion 101 intofitting onto the heart wall surface to bring the suction cup portion 101into communication to the flexible tube 102, the heart wall can besucked with the suction cup portion 101. In addition, removal of thesuction cup portion 101 from the heart wall can be implemented byadjusting the three-way cock 103, interrupting communication to thesuction source 106 and being released with the atmosphere.

Next, in the coronary artery bypass grafting device shown in FIG. 1, theconnecting member 107 is a member that is provided between the suctioncup portion 101 and the flexible tube 102, is in communication to thesuction cup portion 101 and the flexible tube 102 and brings the bothinto connection. In addition, the connecting member 107 makes one of thesuction cup portion 101 and the flexible tube 102 movable against theother. For example, the both may be brought into connection with theconnecting member 107 so that the flexible tube 102 can move arbitrarilyagainst the suction cup portion 101.

In FIG. 1, the posture of one of the suction cup portion 101 and theflexible tube 102 is configured to made variable against the other. Inparticular, the direction of one of the suction cup portion 101 and theflexible tube 102 is made variable against the other. Thus, the flexibletube 102 is movable against the suction cup portion 101, therefore canabsorb torsion stress at the time of pulling the flexible tube 102 inthe direction different from the original connecting direction as wellas stress applied to the suction cup portion 101 by heart beats, preventrelease of the suction cup portion 101 from the heart wall surface andimprove safety. As the connecting member 107 for the flexible tube 102to derive arbitrary movability against the suction cup portion 101, abellows tube in communication to the suction cup portion 101 as well asthe flexible tube 102, for example, can be employed.

In addition, the connecting member 107 may be configured to make anangular movable range of the above described flexible tube being notless than 30 degrees and not more than 180 degrees against the abovedescribed suction cup portion, in the horizontal plane in parallel tothe attachment surface of the suction cup portion 101. In addition, itmay be configured to make an angular movable range of the abovedescribed flexible tube being not less than 30 degrees and not more than180 degrees against the above described suction cup portion, in theperpendicular plane perpendicular to the attachment surface of thesuction cup portion 101. By making the angular movable range to be morethan or equal to 30 degrees, movement freedom of the flexible tube 102against the suction cup portion 101 can be ensured sufficiently. Inaddition, by making the angular movable range to be less than or equalto 180 degrees, an occurrence of torsion on the heart wall surfaceattached to the suction cup portion 101 can be restrained so thatholding is ensured.

In addition, the connecting member 107 is preferably connected in thevicinity of the center of the suction cup portion 101 in a plan view.This can give rise to a configuration that applies uniform stress to thesuction cup portion 101 when the flexible tube 102 is pulled.Consequently, damages to a heart at the time of suction can beprevented. In addition, the connecting member 107 preferably brings theboth of the suction cup portion 101 and the flexible tube 102 intoconnection so that the attachment surface of the suction cup portion 101will be horizontal in the extending direction of the flexible tube 102.Thereby, bulkiness of the suction cup portion 101 can be restrained.Therefore, a heart can become fixable in an ensured fashion in a limitedspace.

Next, in the coronary artery bypass grafting device shown in FIG. 1, theflexible tube 102 is provided with an opening and closing member. Theopening and closing member can be configured by a three-way cock 103 asshown in FIG. 1. More than or equal to one three-way cock 103 can beprovided to each auxiliary tube. This enables adjustment of therespective three-way cocks 103 individually to adjust the suction stateof each suction cup portion 101.

In addition, in case of adopting the three-way cock 103 as the openingand closing member, a stopper may be provided to prevent rotation to onedirection so as to enable limitation of adjustment only in the twodirections. This will enable rotation adjustment of the cock to perform:

-   i) an ensured suction operation when a heart wall undergoes suction    with the suction cup portion 101, and-   ii) an operation of interrupting and releasing the suction cup    portion 101 from the suction source 106 with the atmosphere when to    remove the suction cup portion 101 from the heart wall.

In addition, as a configuration of enabling the opening and closingmember to be adjustable only in the two directions, besides theconfiguration of rotating a cock such as a three-way cock 103, forexample, a member corresponding to the cock may be configured to beslidable in the direction perpendicular to the flexible tube so that theabove described operations i) and ii) can be performed.

The coronary artery bypass grafting device shown in FIG. 1 has at leastmore than or equal to three attachment members. In case of employing oneattachment member, since a heart is held at only one site, the movablerange of the attached heart is large. In addition, since the heart isheld only from one direction, the heart has a strong force to return tothe original position against the attachment member, displacement orfall of the heart is apt to occur. By providing a plurality ofattachment members, the heart can be held from a plurality ofdirections. Therefore, the force of the heart that intends to return tothe original position is dispersed so that the heart can be held stablyin a predetermined position.

In addition, in the coronary artery bypass grafting device shown in FIG.1, more than or equal to three attachment members are employed. In caseof employing two attachment members, there remains freedom of themovable range of the attached heart. By employing more than or equal tothree attachment members, a heart can be clip and held from more than orequal to three directions. In addition, employment of more than or equalto three attachment members ensures a sufficient area of contacting theheart wall surface and can attach and hold the heart sufficiently.Therefore, the heart can be held more stably at a predeterminedposition.

Next, in the coronary artery bypass grafting device shown in FIG. 1, theflexible tube 102 is provided with a check valve with the direction fromthe suction cup portion 101 to the suction source side being set as theforward direction.

The check valve is configured to be able to restrain a back-flow via thecheck valve without undergoing operations from outside. That is, thecheck valve has a function of circulating fluid in only one direction.In particular, when the base end side of the check valve (the side ofthe suction source 106) has negative pressure to the side of the suctioncup portion 101, an open state occurs so that the suction cup portion101 is attached to the heart wall surface with suction pressure. On theother hand, when the base end side of the check valve (the side of thesuction source 106) has relatively positive pressure to the side of thesuction cup portion 101, a closed state is configured to occur.

Such a check valve has, for example, a couple of valves so as to bebrought into contact each other at the tip end side of the suction cupportion 101 and a closed state is configured to occur. Under a closedstate, since the valves are continuously inclined inward from the wallsurface side of the flexible tube and are brought into contact eachother at the base side, that is the end portion of the side of thesuction source 106, to give rise to tight contact, the flow route offluid is interrupted. In addition, under an open state, since the tip ofthe valves is made separate, a path for fluid is formed between thevalves.

The check valve can be a duckbill valve 111 as shown in FIG. 1. Oneduckbill valve 111 can be provided to each auxiliary tube. The duckbill111 can be provided in its outside with a housing that encloses theduckbill valve 111 so as to be connectable to the auxiliary tube or thebranching part (triple joint 105). Thereby, even if one suction cupportion 101 is released by chance from a heart, suction pressure appliedto the interior of the flexible tube 102 at the side of the suctionsource 106 by the duckbill valve 111 disposed in the flexible tube 102in communication to another suction cup portion 101 will get higherthan, that is, will be relatively in positive pressure with respect tothe suction pressure from the duckbill valve 111 to inside the suctioncup portion 101. The difference pressure generates a back-flow of theair, and by the back-flow, the check valve is closed so as to retainsuction pressure inside the suction cup portion 101, the heart can beheld. In addition, at the time when the suction cup portion 101 isreleased, a person in charge of operations and the like is not requiredto do any operation in particular to the duckbill valve 111, but theback-flow can be interrupted automatically. Consequently, safety ofanastomosis operation can be improved.

Materials for the check valve may be, for example, silicone resin,acrylonitrile rubber, isoprene rubber and elastomers such as urethanelastomer and the like. In addition, the check valve is not limited tothe duckbill valve, but may be another check valve in such as umbrellaform and the like. These check valves can be molded by compressionmolding and the like. In addition, materials for the housing to enclosethe check valves may be, for example, rigid vinyl chloride resin andpolycarbonate resin. These housings can be molded by injection moldingand the like. A housing can be configured by two components so as to beable to enclose the check valve, and the housing having two componentscan be assembled by, for example, ultrasonic sealing under a state ofenclosing the check valve.

In addition, the check valve may be configured to notify the person incharge of operations as an alert in form of leak sounds generated byvibration of the check valve provided to the same flexible tube 102(auxiliary tube) as the flexible tube 102 (auxiliary tube) to which thea released suction cup portion 101 is provided when a suction cupportion 101 attached onto a heart wall surface under predeterminedsuction pressure has been released from the heart in a state where thesuction pressure being given. Moreover, the check valve may beconfigured to generate leak sounds with frequencies from 100 Hz to 10kHz with vibration of the check valve in order to notify the person incharge of operations as an alert of the incident that a suction cupportion 101 attached onto the heart wall surface under suction pressureof −200 mmHg to −400 mmHg has been released from the heart. Thus, atreatment by coronary artery bypass grafting can be implemented furthersafely. Also, the check valves for the prevention of the vacuumbreakdown and for the generation of the leak sound may be providedseparately. For example, the check valve for the prevention of thevacuum breakdown can be formed by the material with low hardness toimprove the deforming ability thereof, the adhesiveness between thecouple of valve bodies, and the ability for preventing the vacuumbreakdown, while the check valve for the generation of the leak soundcan be formed by the material with high hardness to make easier tovibrate and thus to generate the leak sound with higher frequency.

In addition, as the coronary artery bypass grafting device shown in FIG.1, the attachment member can be configured by the opening and closingmember (three-way cock 103) and the check valve (duckbill valve 111)being provided to the flexible tube 102 in this order in series at theback side than the suction cup portion 101 (that is, the side of thesuction source 106) provided in the tip end side of the flexible tube102. Thereby, without deteriorating an effect of the check valve that aheart can be held by another suction cup portion 101 in the case whereone suction cup portion 101 is released from the heart, operations ofthe opening and closing member enable implementation of air releaseinside the suction cup for removing the suction cup portion 101 from theheart wall. Conversely, in case of providing the flexible tube with theopening and closing member in series at the back side than the checkvalve (the base end side, that is, the side of the suction source 106),implementation of air release inside the suction cup for removing thesuction cup portion 101 from the heart wall by operations of the openingand closing member is interrupted by the check valve, which is notpreferable.

Accordingly, in the coronary artery bypass grafting device shown in FIG.1, at least more than or equal to three attachment members are employedso that heart position adjustment with little heart displacement orheart fall is performed so as to enable implementation of anastomosissafely compared with the device to date that only has less than or equalto two attachment members.

In addition, at least one among more than or equal to three attachmentmembers has the duckbill valve 111. Therefore, at the time when thesuction cup portion 101 provided in the attachment member having aduckbill valve 111 or the suction cup portion 101 in the otherattachment members are released from the heart wall surface, theduckbill valve 111 can prevent a back-flow from going through this.

Moreover, in FIG. 1, since all the three attachment members are providedwith duckbill valves 111, back-flows via the duckbill valves can berestrained effectively as to all the flexible tubes.

In addition, the suction cup portion 101 is provided with a plurality ofconcave slits 108 (FIG. 4) so that lateral sliding of the suction cupportion 101 against tissues can be prevented and, moreover, suctionpressure can be applied to reach the end portion of the suction cupportion 101 in an ensured fashion and, therefore, the suction power canbe improved. In addition, by providing the end portion of the suctioncup portion 101 with a pliable member 109 to make the portion pliable,the nature of following the pliable tissues can be improved and thesuction power can be improved.

FIG. 2 and FIG. 3 are drawings schematically showing other configurationexamples of the coronary artery bypass grafting device. Theconfiguration of the coronary artery bypass grafting device shown inFIG. 1 is also applicable to the configuration shown in the followingdrawings. In addition, the configuration shown in FIG. 2 or FIG. 3 isapplicable to the coronary artery bypass grafting device shown in FIG. 1as well. As shown in FIG. 2 or FIG. 3, an X-type joint 110 may be usedin place of the triple joint 105 shown in FIG. 1.

In the coronary artery bypass grafting device shown in FIG. 2, theopening and closing member is disposed in the vicinity of the suctioncup portion 101. In addition, the connecting member 107 is not providedbetween the suction cup portion 101 and the flexible tube 102. Inaddition, the attachment surface of the suction cup portion 101 is fixedin perpendicular to the extending direction of the flexible tube 102.

As the opening and closing member configured to bring the suction cupportion 101 and the flexible tube 102 into connection so that thesuction cup portion 101 is in communication to the flexible tube 102,two-way cock or the three-way cock 103 shown in the drawing can beemployed. This can ensure the ease and convenience of operations of thecoronary artery bypass grafting device.

At the time of use of the coronary artery bypass grafting device shownin FIG. 2, at first, the two-way cock or the three-way cock 103 isadjusted so that communication between the suction cup portion 101 andthe flexible tube 102 from the suction source 106 is interrupted tocause the suction cup portion 101 to fit into the heart wall surface.Thereafter, by adjusting the two-way cock or the three-way cock 103, thesuction cup portion 101 is brought into the state of being incommunication to the flexible tube 102. This enables the suction cupportion 101 to suction the heart wall. In addition, removal of thesuction cup portion 101 from the heart wall can be implemented byadjusting the three-way cock 103, interrupting to derive a state of thesuction cup portion 101 being not in communication to the suction source106 and being released with the atmosphere.

In addition, the holding member 104 is connected to in the vicinity ofthe suction cup portion 101. The holding member 104 adjusts positions ofthe suction cup portion 101. As the material of the holding member 104,a material is preferably unbreakable material. For example, metal suchas stainless steel and the like or resin materials such as polyamideresin, polycarbonate resin, rigid vinyl chloride resin, silicone resinand the like may be the material. The position of a heart attached ontothe suction cup portion 101 is adjustable by pulling the flexible tube102 in communication to the three-way cock 103 disposed in the vicinityof a plurality of the suction cup portion 101 attached onto the heartwall surfaces, or the respective holding members 104 disposed in theflexible tube 102.

In the coronary artery bypass grafting device shown in FIG. 2, bydisposing the three-way cock 103 and the holding member 104 in thevicinity of the suction cup portion 101, operability for the person incharge of operations can be improved.

In addition, the coronary artery bypass grafting device shown in FIG. 3is provided with the three-way cock 103 being the opening and closingmember and the holding member 104 in the location apart from the suctioncup portion 101 in the coronary artery bypass grafting device in FIG. 2.By disposing the three-way cock 103 and the holding member 104 apart andseparately from the suction cup portion 101, peripheral bulkiness of thesuction cup portion 101 can be caused to decrease. Therefore, even thecase where space between the heart and the pericardium being theperiphery of the heart is small, there are effects that the sitesuctioning the heart will not be limited.

Here, in the coronary artery bypass grafting device shown in FIG. 2 andFIG. 3, flexible tubes 102 in communication to a plurality of suctioncup portions 101 brought into attachment onto a heart wall surface andrespective holding members 104 that are disposed at the three-way cocks103 being opening and closing members may be pulled and fixed to a ribretractor and the like with forcepts and the like.

Second Embodiment

In the coronary artery bypass grafting device according to the firstembodiment, the suction cup portion 101 may be configured by at leasttwo or more subround suction cups. Since the suction cup portion 101 hasat least two or more subround suction cups, the device excels intrackability during attachment to a curved surface as well as thesubstantially flat portion of the heart wall surface, therebysuccessfully hold the heart at a predetermined position with highaccuracy. Furthermore, the attachment to the heart wall surface can berealized on the largest possible contact area without suctioning bloodvessels. The differences of the present embodiment from the firstembodiment are mainly explained below more concretely by referring toFIG. 6, FIG. 7( a) to FIG. 7( e), and FIG. 8.

FIG. 6 shows an example of a coronary artery bypass grafting deviceaccording to the present invention. The coronary artery bypass graftingdevice shown in FIG. 6 includes plural (three in FIG. 6) attachmentmembers. Each attachment member includes: a flexible tube 102; a suctioncup portion 101 having two suction cups 150 attached at the tip end sideof the flexible tube 102; a three-way cock 103 as an opening and closingmember provided for the flexible tube 102; the holding member 104 forholding the flexible tube 102; and the duckbill valve 111 as a checkvalve provided for the flexible tube 102.

The suction cup 150 is contained in the suction cup portion 101 and hasa subround (subround-shaped) flat portion in FIG. 6. In FIG. 6, thesuction cup 150 is contained in one of the suction cup portions 101.

In the coronary artery bypass grafting device shown in FIG. 6, thesuction cup portion 101 having two suction cups 150 is provided on thetip end side of the flexible tube 102. Specifically, as described above,the three suction cup portions 101 are connected to the end portion ofeach of the three auxiliary tubes branched from one main tube. Thesuction cup portions 101 are suctioned by the suction source 106 throughthe flexible tube 102. By the suction, the suction cup portions 101attach to the surface of an object to be attached.

The object to be attached is a heart. Therefore, the suction cupportions 101 having two suction cups 150 can be materials excellent inadhesion to the heart. The material of the suction cup portion 101 canbe, for example, an elastic substance. Thus, the suction cup portion 101can be sufficiently fitted to the heart wall surface, thereby ensuringthe adhesion. Specifically, the material of the suction cup portion 101is preferably a silicone resin, a styrene-ethylene-butadiene-styreneresin, elastomer such as urethane elastomer, and the like.

The suction cup portion 101 may have at least two suction cups 150.Since it includes at least two suction cups 150, it is excellent intrackability during attachment not only to the substantially flatportion but also to the curved surface of the heart wall surface,thereby holding the heart at a predetermined position with highaccuracy. Furthermore, the attachment to the heart wall surface can berealized on the largest possible contact area without suctioning bloodvessels on the heart wall surface.

When the flat shape of the suction cup 150 is substantially circular,the size of the suction cup 150 of the suction cup portion 101 can be 5mm or more in diameter, and can be preferable 10 mm or more. Thus, thesuction cup 150 can furthermore stably attach to the heart wall surface.The diameter of the suction cup 150 of the suction cup portion 101 canalso be, for example, 50 mm or less, and can be preferable 40 mm orless. Thus, with plural suction cups 150, the suction cup portion 101can be smaller, thereby surely suppressing the obstruction of thesuction cup 150 to an operation. Additionally, the height of the suctioncup portion 101 can be, for example, 5 mm or more from the view of morestable attachment to the heart wall surface. In downsizing the suctioncup portion 101, the height of the suction cup portion 101 can be, forexample, 30 mm or less.

With the above-mentioned configuration for the size of the suction cupportion 101, the suction cup portion 101 can surely attach to thesurface of the heart, thereby fixing the position of the heart.Furthermore, the effect of an operation can be ensured with the suctioncup portion 101 stably fixing on the surface of the heart.

It is preferable that the shape of the suction cup portion 101 of thecoronary artery bypass grafting device shown in FIG. 6 is tapered, thatis, the diameter of the suction cup portion 101 is to increase towardthe end portion of the suction cup 150. Thus, when the suction cupportion 101 is suctioned and contacted with the heart wall surface, thesuction cup 150 of the suction cup portion 101 can be prevented frombeing pulled inside by the suction pressure. The sizes or the shapes ofthe plural suction cup portions 101 are not limited to the same. Forexample, the suction cup portion 101 to be fitted to the cardiac apex ofthe heart can be the largest. Thus, the heart can surely be held at apredetermined position.

The suction cup portion 101 having the suction cup 150 can be providedwith an opening on the attachment surface. The opening can be configuredto communicating to the flexible tube 102. In addition, there may bemeshes having a number of small holes covering the opening of thesuction cup portion 101. At this time, the wall surface of the heart isconfigured to contact to the suction cup portion 101 through the meshes.

It is preferable that plural concave slits are formed inside the openingof the suction cup portion 101 having the suction cup 150. FIG. 7(A) toFIG. 7( e) are explanatory views of the configuration of the suction cupportion 101 having slits. FIG. 7( a) is a front view of the suction cupportion 101. FIG. 7( b) is a top view of the suction cup portion 101.FIG. 7( c) is a bottom view of the suction cup portion 101. FIG. 7( d)is a sectional view along A to A′ shown in FIG. 7( b). FIG. 7( e) is asectional view along B to B′ shown in FIG. 7( b).

FIG. 7( a) to FIG. 7( e) show the cases of the suction cup 150 of thesuction cup portion 101. In the configuration, as with the caseaccording to the first embodiment, the suction cup 150 is provided witha communication opening (not shown in the drawings) communicating to theflexible tube 102 and plural concave portions (slits 108) extending fromthe end portion of the suction cup 150 to the communication opening. Theslits 108 are grooves formed inside the suction cup portion 101. Byproviding the slits 108, from the slits 108 through the communicationopening, the liquid in the suction cup portion 101 can be efficientlydrained to the flexible tube 102. Therefore, the suction cup portion 101can be prevented from containing a liquid to be blocked the drain pathand the draining effects of draining body fluid and the like on tissuesurfaces can be derived, which can prevent the suction cup portion 101from lateral sliding against tissues. Furthermore, as shown in FIG. 7(c) to FIG. 7( e), the concave portions of the plural slits extendsubstantially perpendicularly (in the suction direction) to theattachment surface, and are substantially parallel to each other.

In the coronary artery bypass grafting device shown in FIG. 6, it ispreferable that the end portion of each suction cup 150 forming part ofthe suction cup portion 101 is a pliable or soft portion. FIG. 8 is afront view as a schematic view showing the configuration of the suctioncup portion 101 with the above-mentioned structure. In FIG. 8, since thepliable member 109 is provided at the end portion of the suction cup 150of the suction cup portion 101, the end portion of the suction cupportion 101 is a pliable of flexible portion. The end portion of thesuction cup portion 101 is softer than the inside of the suction cupportion 101. Thus, the trackability of the suction cup portion 101 to apliable organ can be furthermore enhanced and the suction force can beimproved. The pliable member 109 can be, for example, the materialdescribed above by referring to the first embodiment.

In the coronary artery bypass grafting device shown in FIG. 6, theconnecting member 107 is provided between the suction cup portion 101and the flexible tube 102, or between the suction cups 150 of thesuction cup portion 101 so that they can be connected. The connectingmember 107 allows the direction of one of the suction cup 150 and theflexible tube 102 to be variable to the direction of the other, andallows one of the suction cup portion 101 and the flexible tube 102 tobe movable from the other. Likewise, the connecting member 107 may allowone of the two suction cups 150 of the suction cup portion 101 to bevariable to the other, and allow one of the suction cups 150 of thesuction cup portion 101 to be movable from the other. Since the postureof the flexible tube 102 is movable relative to the suction cup 150 inthe suction cup portion 101, the torsion stress or the stress by thepulse of the heart can be absorbed when the flexible tube 102 is pulledin the direction different from the first connection direction, and thesuction cup portion 101 can be prevented from being detached from theheart wall surface, thereby improving the safety. Additionally, sincethe posture of one of the suction cups 150 of the suction cup portion101 is movable relative to the other, the trackability of the suctioncup 150 during attachment can be furthermore improved not only on thesubstantially flat portion of the heart wall surface, but also on thecurved surface. As the connecting member 107 for allowing the flexibletube 102 to be arbitrarily movable relative to the suction cup portion101, or the connecting member 107 for allowing one of the suction cups150 of the suction cup portion 101 to be movable relative to the other,for example, a bellows tube for communication with the suction cup 150and the flexible tube 102 can be used.

The connecting member 107 may also be configured such that the angularmovable range of the flexible tube 102 relative to the suction cupportion 101 on the plane parallel to the attachment surface of thesuction cup portion 101, or the angular movable range of one of thesuction cups 150 of the suction cup portion 101 relative to the othercan be 30 degrees or more and 180 degrees or less. The connecting member107 may also be configured such that the angular movable range of theflexible tube 102 relative to the suction cup portion 101, or theangular movable range of one of the suction cups 150 of the suction cupportion 101 relative to the other on the vertical plane perpendicular tothe attachment surface of the suction cup portion 101 can be 30 degreesor more and 180 degrees or less. By setting the angular movable range as30 degrees or more, the freedom of the movement of the flexible tube 102relative to the suction cup portion 101, or the freedom of the movementof one of the suction cups 150 of the suction cup portion 101 relativeto the other can be sufficiently ensured. By setting the angular movablerange as 180° or less, the torsion in the heart wall surface attached tothe suction cup portion 101 can be suppressed, thereby holding the heartwith high accuracy.

Third Embodiment

In the coronary artery bypass grafting device according to theabove-mentioned embodiments, an attachment member may further include anauxiliary member for use in arranging a suction cup portion at apredetermined position of an object to be attached. The case in whichthe coronary artery bypass grafting device according to the firstembodiment is used is explained below by referring to FIG. 9 and FIG.10.

FIG. 9 is a schematic view showing the configuration of the coronaryartery bypass grafting device according to the present embodiment. FIG.10 is a plan view of an example of the configuration of an insertionauxiliary member 112 of the coronary artery bypass grafting device shownin FIG. 9.

The coronary artery bypass grafting device shown in FIG. 9 is configuredto further provide the insertion auxiliary member 112 for the coronaryartery bypass grafting device shown in FIG. 1.

The insertion auxiliary member 112 is used in arranging the suction cupportion 101 at a predetermined position of the heart wall surface. Theinsertion auxiliary member 112 is configured to be removable from thesuction cup portion 101. Practically, it includes a pole-shaped graspingunit and an engagement unit which is provided at the end portion of thegrasping unit and is engaged as removable from the suction cup portion.An operator grasps the grasping unit directly or using a graspingmember, arranges the suction cup portion 101 at a predetermined positionof the heart wall surface, thereby attaching the suction cup portion 101to the wall surface.

The shape of the tip portion of the insertion auxiliary member 112, thatis, the shape of the plane of the engagement unit may be, for example,U-shaped. Thus, the U-shaped portion at the tip portion of the insertionauxiliary member 112 encloses the suction cup portion, and the insertionauxiliary member 112 is pushed into the U-shaped portion, thereby easilyarranging the suction cup portion 101 in the heart wall surface. Theinsertion auxiliary member 112 can be curved into an arbitrary shape.Thus, the suction cup portion 101 can also be arranged on the heart wallportion on the back of the heart.

The pole-shaped portion is configured by a material having the hardnessallowing the portion to be arbitrarily changed during operation. Thematerial of the insertion auxiliary member 112 can be metal and thelike, such as stainless-steel and the like. Thus, the hardness withwhich an operator can easily change the shape can be acquired with thehardness of the insertion auxiliary member 112 maintained. Therefore,the effect of the pushing the suction cup portion 101 using theinsertion auxiliary member 112 can be improved.

The size of the insertion auxiliary member 112 can be, for example, 50mm or more in total length, and 100 mm or more preferably. In the caseof the above-mentioned U-shaped tip end portion, the outer diameter ofthe U-shaped portion can be, for example, 2 mm or more and 4 mm or less.

As shown in FIG. 9 and FIG. 10, in the present embodiment, the insertionauxiliary member 112 whose shape can be arbitrarily changed and whichcan be removable from the above-mentioned suction cup portion 101 of thecoronary artery bypass grafting device is provided. Thus, as comparedwith the state in which the entire heart is exposed by the mediansternotomy, the arrangement of the suction cup portion on the heart wallsurface can be facilitated with the heart partially exposed by thecostotome of a smaller scale by which the suction portion is difficultto be arranged on the heart wall surface.

Specifically, the insertion auxiliary member 112 is hung on the suctioncup portion 101, and the insertion auxiliary member 112 is grasped andmoved, thereby positioning the suction cup portion 101 at apredetermined position. Then, a suction pressure is applied to thesuction cup portion 101, after the suction cup portion 101 is attachedto the heart wall surface, the insertion auxiliary member 112 is pulledtoward the operator, and thereby the insertion auxiliary member 112 canbe separated from the suction cup portion 101 and removed. Thus, whenthe insertion auxiliary member 112 is provided, the insertion auxiliarymember 112 is prevented from interrupting the operation using theinsertion auxiliary member 112.

Fourth Embodiment

The present embodiment relates to a method of performing a surgicaltherapy on a heart using a coronary artery bypass grafting devicedescribed in the above-mentioned embodiments. The case using thecoronary artery bypass grafting device shown in FIG. 1 is explained byreferring to FIG. 11. In the coronary artery bypass grafting deviceshown in FIG. 11, a first suction cup portion 101 a, a second suctioncup portion 101 b, and a third suction cup portion 101 c are provided asthe suction cup portion 101. The tubular holding member 104 is arrangedparallel to the flexible tube 102 of each attachment member. The holdingmember 104 is arranged at the suction source side 106 (not shown in thedrawings) not beyond the communicating member 107, that is, closer tothe base end side.

In the present embodiment, for example, the operation can be performedin the following procedure.

-   Step 101: When a heart is in the first position, a suction cup    portion (first suction cup portion 101 a) is arranged in a    predetermined position of the heart wall surface.-   Step 102: A suction pressure is applied to the first suction cup    portion 101 a, and the first suction cup portion 101 a is attached    to a predetermined position.-   Step 103: Another suction cup portion (second suction cup portion    101 b) is arranged in another position of the heart wall surface.-   Step 104: Using the same suction source as the suction source (not    shown in the drawings) from which the suction pressure is applied to    the first suction cup portion 101 a, the suction pressure is applied    to the second suction cup portion 101 b, and the second suction cup    portion 101 b is attached to another position.-   Step 105: A further suction cup portion (third suction cup portion    101 c) is arranged in a further position on the heart wall surface.-   Step 106: Using the same suction source as the suction source (not    shown in the drawings) from which the suction pressure is applied to    the first suction cup portion 101 a, the suction pressure is applied    to the third suction cup portion 101 c, and the third suction cup    portion 101 c is attached to a further position.-   Step 107: The heart is held in the second position by drawing and    holding: a holding member 104 for holding the flexible tube 102 for    which the first suction cup portion 101 a is provided; another    holding member 104 for holding the flexible tube 102 for which the    second suction cup portion 101 b is provided; and a further holding    member 104 for holding the flexible tube 102 for which the third    suction cup portion 101 c is provided.-   Step 108: A surgical therapy is performed on the heart in the second    position.

To be more concrete, with the heart completely exposed by the mediansternotomy and placed in the first position, the first suction cupportion 101 a and the second suction cup portion 101 b are arranged atthe peripheral portion of the heart wall surface, attached by thesuction pressure of −300 mmHg, and the third suction cup portion 101 cis arranged at the lower portion of the heart wall surface, and attachedby the suction pressure of −300 mmHg. Then, each holding member 104 isdrawn, the holding member 104 is fixed to the operation area drape 113by the holder 114, and the heart is held in the second position. Withthe heart 116 in the second position, the coronary artery 117 as atarget of a bypass anastomosis is exposed, and is drawn from threedirections so that the heart cannot be deformed, therefore the pulsingheart can be stably held. Therefore, according to the presentembodiment, the bypass anastomosis can be safely and surely performed.Although not shown in the drawings, the first suction cup portion 101 a,the second suction cup portion 101 b, and the third suction cup portion101 care communicating with the same suction source.

In the explanation above, three suction cup portions 101 (the suctioncup portion 101 a to the suction cup portion 101 c) are provided, butwhen two suction cup portions 101 are used, the heart is to be held inthe second position by drawing and holding a holding member 104 forholding the flexible tube 102 provided with the first suction cupportion 101 a and another holding member 104 for holding the flexibletube 102 provided with the second suction cup portion 101 b in step 107after step 101 to step 104 above, and then the process in step 108 is tobe performed.

Described above are the embodiments according to the present invention.These embodiments are exemplified only, and those skilled in the artunderstand that there are many other variations that are within thescope of the present invention. Furthermore, the present invention isnot limited to the coronary artery bypass grafting device not for aheart, but also can be applied to other organs, which is well understoodby those skilled in the art.

For example, the above-mentioned coronary artery bypass grafting deviceis configured as having three suction cup portions 101 connected to thesuction source 106, but the number of suction cup portions 101 are threeor more, that is, four suction cup portions may also be used.

It is also possible to provide a trap between the above-mentionedcoronary artery bypass grafting device and the suction source 106 totrap blood, body fluid, lavage fluid and the like.

The above-mentioned coronary artery bypass grafting device can be notonly used as a treatment tool for a heart of a person but also used as atreatment tool for a heart of other animals such as mammalia and thelike.

The invention claimed is:
 1. A coronary artery bypass grafting device comprising: a plurality of attachment members each including: a flexible tube; a suction cup portion, having a communication opening that communicates with said flexible tube, provided at a tip end side of said flexible tube; a switching member provided in said flexible tube; and a holding member that holds said flexible tube, a branch portion that communicates with each flexible tube of said plurality of attachment members; and a main tube that communicates with said branch portion for connecting with a suction unit, wherein at least one of said attachment members further includes a check valve provided in said flexible tube, said switching member switches between a state for bringing said communication opening into communication with said branch portion, and a state for interrupting communication between said communication opening and said branch portion, and said check valve circulates fluid from said communication opening side to said branch portion side in only one direction.
 2. The coronary artery bypass grafting device according to claim 1, wherein at least one of said attachment members further comprises an auxiliary member used for placing said suction cup portion in a predetermined position on a subject to be attached.
 3. The coronary artery bypass grafting device according to claim 1, wherein said device comprises at least three attachment members.
 4. The coronary artery bypass grafting device according to claim 1, wherein said check valve has a couple of valve bodies which are in contact with each other at tips of said valve bodies to be in a closed state, and said check valve is adapted to be opened when a base end side of said check valve is at a negative pressure with respect to said suction cup portion, and closed when the base end side of said check valve is at a relatively positive pressure with respect to said suction cup portion.
 5. The coronary artery bypass grafting device according to claim 1, wherein said check valve is a duckbill valve.
 6. The coronary artery bypass grafting device according to claim 1, wherein said check valve provided in said flexible tube provided with said suction cup portion is adapted to vibrate and generate a leak sound when the suction cup portion attached to the subject to be attached under a predetermined suction pressure is detached with said suction pressure being applied.
 7. The coronary artery bypass grafting device according to claim 1, further comprising a connecting member that connects said suction cup portion and said flexible tube between said suction cup portion and said flexible tube, wherein said connecting member communicates with said suction cup portion and said flexible tube, and is adapted so that the orientation of one of said suction cup portion and said flexible tube is variable relative to the other.
 8. The coronary artery bypass grafting device according to claim 7, wherein said connecting member comprises a bellows tube communicating with said suction cup portion and said flexible tube.
 9. The coronary artery bypass grafting device according to claim 8, wherein an angular movable range of said flexible tube relative to said suction cup portion is not less than 30 degrees and not more than 180 degrees in a vertical plane perpendicular to the attachment surface of said suction cup portion.
 10. The coronary artery bypass grafting device according to claim 7, wherein an angular movable range of said flexible tube relative to said suction cup portion is not less than 30 degrees and not more than 180 degrees in a horizontal plane parallel to an attachment surface of said suction cup portion.
 11. The coronary artery bypass grafting device according to claim 1, wherein said suction cup portion further comprises: a plurality of slit-like concaves extending from an end of said suction cup portion toward said communication opening.
 12. The coronary artery bypass grafting device according to claim 1, wherein the end portion of said suction cup portion is formed of a member softer than the inside of said suction cup portion.
 13. The coronary artery bypass grafting device according to claim 1, wherein said suction cup portions communicate with one suction unit via said flexible tube.
 14. The coronary artery bypass grafting device according to claim 1, wherein said check valve is arranged between said switching member and said branch portion in at least one of said attachment members.
 15. The coronary artery bypass grafting device according to claims 1, wherein said suction cup portion comprises a plurality of suction cups in at least one of said attachment members.
 16. The coronary artery bypass grafting device according to claim 15, wherein the shape of said suction cups is substantially circular.
 17. A coronary artery bypass grafting device comprising: a plurality of attachment members each having: a flexible tube; a suction cup portion, having a communication opening that communicates with said flexible tube, provided at a tip end side of said flexible tube; a switching member provided in said flexible tube; a holding member that holds said flexible tube; and a check valve provided in said flexible tube a branch portion that communicates with each flexible tube of said plurality of attachment members; and a main tube that communicates with said branch portion for connecting with a suction unit, wherein said switching member switches between a state for bringing said communication opening into communication with said branch portion, and a state for interrupting communication between said communication opening and said branch portion, and said check valve circulates fluid from said communication opening side to said branch portion side in only one direction.
 18. A method for surgically treating a heart using a coronary artery bypass grafting device comprising a plurality of attachment members each including: a flexible tube; a suction cup portion, having a communication opening that communicates with said flexible tube, provided at a tip end side of said flexible tube; a switching member provided in said flexible tube; and a holding member that holds said flexible tube, a branch portion that communicates with each flexible tube of said plurality of attachment members; and a main tube that communicates with said branch portion for connecting with a suction unit, wherein at least one of said attachment members further includes a check valve provided in said flexible tube, said switching member switches between a state for bringing said communication opening into communication with said branch portion, and a state for interrupting communication between said communication opening and said branch portion, and said check valve circulates fluid from said communication opening side to said branch portion side in only one direction; wherein the method comprises attaching said suction cup portion to a heart wall surface while applying a suction pressure to said suction cup portion of said plurality of attachment members by sucking said main tube using said suction unit, in a state that said switching member brings said communication opening into communication with said branch portion; and surgically treating said heart.
 19. The method according to claim 18, wherein attaching said suction cup portion to said heart wall surface includes: placing a first suction cup portion in a predetermined position on said heart wall surface when the heart is in a first position; applying a suction pressure to said first suction cup portion by said suction unit and attaching said first suction cup portion to said predetermined position; placing a second suction cup portion in a second position on said heart wall surface; applying a suction pressure to said second suction cup portion by said suction unit and attaching said second suction cup portion to said second position and; pulling and holding a first holding member that holds a flexible tube provided with said first suction cup portion and a second holding member that holds a flexible tube provided with said second suction cup portion to hold the heart in a second position; wherein, said heart is surgically treated while in said second position.
 20. The method according to claim 19, wherein at least one of said attachment members further comprises an auxiliary member used for placing said suction cup portion in a predetermined position on a subject to be attached, and placing said first suction cup portion in the predetermined position on the heart wall surface comprises placing said first suction cup portion in said predetermined position with said auxiliary member.
 21. The method according to claim 18, wherein attaching said suction cup portion to said heart wall surface includes: placing a first suction cup portion in a predetermined position on said heart wall surface when the heart is in a first position; applying a suction pressure to said first suction cup portion by said suction unit and attaching said first suction cup portion to said predetermined position; placing a second suction cup portion in a second position on said heart wall surface; applying a suction pressure to said second suction cup portion by said suction unit and attaching said second suction cup portion to said second position; placing a third suction cup portion in a third position on said heart wall surface; applying a suction pressure to said third suction cup portion by said suction unit and attaching said third suction cup portion to said third position; and pulling and holding a first holding member that holds a flexible tube provided with said first suction cup portion, a second holding member that holds a flexible tube provided with said second suction cup portion, and a third holding member that holds a flexible tube provided with said third suction cup portion to hold the heart in a second position; wherein, said heart is surgically treated while in said second position.
 22. The method according to claim 21, wherein at least one of said attachment members further comprises an auxiliary member used for placing said suction cup portion in a predetermined position on a subject to be attached, and placing said first suction cup portion in the predetermined position on the heart wall surface comprises placing said first suction cup portion in said predetermined position with said auxiliary member. 